不同时机行硬膜外镇痛和家庭化产房对初产妇分娩方式及结局的影响

Effect of epidural analgesia on delivery methods and outcomes of primiparous women in home-based delivery rooms and general wards at different times

目的探讨不同时机实施硬膜外镇痛和家庭化产房对初产妇分娩方式及结局的影响。方法收集于2019年10月至2022年2月期间,在滨州医学院附属医院临产后自愿要求实施硬膜外镇痛分娩的初产妇402例为研究对象,其中根据初产妇选择产房的意愿及实施硬膜外镇痛时机进行分组,选择家庭化产房且宫颈口扩张<3 cm行硬膜外镇痛的初产妇107例、选择家庭化产房且宫口扩张≥3 cm行硬膜外镇痛的初产妇100例、选择普通产房且宫颈口扩张<3 cm行硬膜外镇痛的初产妇79例和选择普通产房且宫口扩张≥3 cm行硬膜外镇痛的初产妇116例。通过比较四组的一般临床资料、镇痛前后视觉模拟疼痛评分(VAS)、各产程时间、顺转剖宫产率、分娩出血量、侧切率、缩宫素使用率、人工破膜率及新生儿的各项指标情况等来研究不同时机实施硬膜外镇痛对选择家庭化产房和普通病房初产妇分娩方式及结局的影响。采用SPSS 26.0软件进行分析。结果家庭化产房+宫颈口扩张<3 cm组、普通产房+宫颈口扩张<3 cm组总产程均较家庭化产房+宫颈口扩张≥3 cm组延长,普通产房+宫颈口扩张<3 cm组总产程较普通产房+宫颈口扩张≥3 cm组延长,家庭化产房+宫颈口扩张<3 cm组、普通产房+宫颈口扩张<3 cm组第一产程较家庭化产房+宫颈口扩张≥3 cm组延长,普通产房+宫颈口扩张<3 cm组第一产程较普通产房+宫颈口扩张≥3 cm组延长,家庭化产房+宫颈口扩张≥3 cm组第二产程较普通产房+宫颈口扩张≥3 cm组缩短,P<0.05;家庭化产房+宫颈口扩张≥3 cm组侧切率低于普通产房+宫颈口扩张≥3 cm组,P<0.05,普通产房+宫颈口扩张<3 cm组缩宫素使用的百分率大于家庭化产房+宫颈口扩张≥3 cm组,P<0.05;家庭化产房+宫颈口扩张<3 cm组顺转剖宫产率大于家庭化产房+宫颈口扩张≥3 cm组,P<0.05。结论宫颈口扩张<3 cm行实施硬膜外分娩镇痛会一定程度上延长总产程、第一产程时间、同时增加顺转剖宫产率,家庭化产房的应用使第二产程时间相对缩短、侧切率相对降低,各组第三产程及新生儿结局无显著差异,对镇痛前后VAS、人工破膜率及分娩出血量等无影响,因此家庭化产房并且宫口扩张≥3 cm行硬膜外分娩镇痛为最佳分娩选择。

Objective To explore the impact of epidural analgesia at different times on the selection of delivery methods and outcomes for primiparous women in family delivery rooms and general wards.Methods From October 2019 to February 2022,402 primiparas who voluntarily requested epidural analgesia after delivery in Binzhou Medical University Hospital were collected as the study subjects.According to the willingness of primiparas to choose the delivery room and the time to implement epidural analgesia,they were divided into groups.The primiparas who chose the home-based delivery room and performed epidural analgesia with cervical dilatation<3cm were group A(107 cases),group B(100 cases)with primiparous women in the family delivery room and cervical dilation≥3 cm for epidural analgesia,group C(79 cases)with primiparous women in the regular delivery room and cervical dilation<3 cm for epidural analgesia,and group D(116 cases)with primiparous women in the regular delivery room and cervical dilation≥3 cm for epidural analgesia.By comparing the general clinical data,visual analogue pain score(VAS)before and after analgesia,the time of each birth process,the rate of anterograde cesarean section,the amount of bleeding during delivery,the rate of lateral incision,the rate of oxytocin use,the rate of artificial rupture of membranes,and various indicators of newborns of the four groups,the impact of epidural analgesia at different times was studied on the choice of delivery methods and outcomes of home-based delivery rooms and general wards for primipara.SPSS 26.0 software was used for analysis.Results The total labor process in group A and group C was longer than that in group B,while the total labor process in group C(10.83±4.54 hours)was longer than that in group D.The first labor process in group A and group C was longer than that in group B,the first labor process in group C was longer than that in group D,and the second labor process in group B was longer than that in group D,P<0.05;the lateral resection rate in group B was lower than that in group D,P<0.05.The percentage of oxytocin use in group C was higher than that in group B,P<0.05;the rate of antegrade cesarean section in group A was higher than that in group B,P<0.05.Conclusion Epidural labor analgesia with dilation of cervical orifice<3 cm can prolong the total labor process,the time of the first labor process,and increase the antegrade cesarean section rate to a certain extent.The application of the family delivery room can shorten the second labor process and reduce the side cut rate.There is no significant difference between the third labor process and the newborn outcome in each group.It has no effect on the visual simulation pain score,the artificial membrane breaking rate,and the amount of labor bleeding before and after analgesia,therefore,the best delivery option is to use a family oriented delivery room with a dilation of the uterine opening≥3cm for epidural labor analgesia.